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General Practice: Unable to Cope?

I have been shaken recently by claims that in England you might have to wait 2-3 weeks for a GP appointment. The most recent instance was during an interview on the BBC’s ‘Newsnight’ programme yesterday evening, Dame Julie More, the CEO of the Queen Elizabeth Hospital, Birmingham, remarked, in what was little more than an aside, that she had spoken to a patient in A&E that morning who had stated she had been told by her GP there was a 3 week wait for an appointment “so I’ve come here.”

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It is no wonder that A&Es up and down the country are under such pressure if they are, in effect, being utilised as a substitute for the traditional family doctor. Waiting more than a few hours for an appointment seems impractical. Either your symptoms will have got much worse making your case an urgent one, or they will have disappeared. I feel fine now, but I could be dead in 3 weeks time. If my demise is preceded by symptoms of ill health I will want those symptoms to be assessed by a professional as soon as possible.

I can recall a time when you could walk into a doctor’s surgery during morning or evening surgery hours and expect to be seen within an hour or less. At other times the doctor would be conducting home visits. In the early months of 1961 I contracted a nasty cough. I visited our doctor’s surgery and was diagnosed with Bronchitis. I remained in bed at home for several weeks, during which the doctor made several visits. He eventually revised the diagnosis to Whooping Cough.

the-doctorI have been looking at articles on-line dealing with recent developments in General Practice. In a paper published in The Lancet in April 2016 researchers from Oxford University noted that, between 2007 and 2014 “average consultation rates over the 7 years, [rose] 10.5% from 4.67 consultations per person per year in England in 2007/8 to 5.16 in 2013/14. [Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14, published online in The Lancet on 6 April.]

Interestingly, this compares to figures gleaned from another paper dealing with the history of General Practice in England, this one published by the BMJ in January 2006 entitled A century of general practice by Zosia Kmietowicz. Discussing the years immediately following the creation of the NHS it states that “The average number of times a patient consulted their general practitioner rose from 4.8 a year in 1947 to 5.6 in 1950

At that time GPs made many more home visits than they do today: “In 1953, general practitioners were estimated to be making between 12 and 30 home visits each day and seeing between 15 and 50 patients in their surgeries.” As this article in The Daily Mail on-line from February 2016 says, the BMA has advised doctors to reduce or eliminate home visits – a service that was already much reduced by 2007.

GP surgeries today would be unrecognisable to the family doctor that cared for me back iin 1961. These days they operate with several doctors sharing a practice. They also employ practice nurses, receptionists and probably have a Practice Manager to look after all the paperwork. They also, of course, have the kind of diagnostic equipment that, if it existed at all 56 years ago, would have been available only in hospitals. All of this is surely intended to reduce the work load of hospitals.

According to Zosia Kmietowicz’s paper, by 2002 general practitioners controlled 75% of the NHS budget. Am I being too controversial in suggesting that, rather than forcing patients to attend hospitals, they should be using that colossal financial power to provide a better service in the communities they are supposed to serve.017

The problem, of course, is that we are all living longer. At the time of my birth, in 1941, I could have been expected to live until I was 60. My wife, born in 1945, would have been expected to live until she was 67. We have already lived an extra 15 and 4 years respectively. Fortunately we both enjoy reasonably good health. Many of our contemporaries are less fortunate and have already survived conditions that would undoubtedly have killed them in past decades. That is the result of the many treatments and diagnostic tools available today that did not exist just a few decades ago. Meanwhile, whilst the number of GPs employed in England increased between 2004 and 2014, that increase was insufficient and numbers have since fallen slightly.

General Practice remains the first point of contact with health services for most people. It cannot continue to be so if it is not possible for that contact to take place within a short time of the onset of symptoms.